NCM 116: CARE OF CLIENTS W/ PROBS IN NUTRTION GI METABOLISM & ENDOCRINE,

PERCEPTION & COORD. ACUTE & CHRONIC W/ RLE 204 HOURS

NCM 116: ENDO

COURSE OUTLINE: midterm -- Follicle stimulating Hormone

1. Organs involved in the Endocrine System  Prolactin RH -- Prolactin
2. Disorders in the Endo System:
A. Growth Hormone
B. RAAS System
C. Thyroid PINEAL GLAND
 Receive info from retina if day or night
REFERENCE BOOK  DAY - ↓ melatonin
 NIGHT - ↑ melatonin
ORGANS INVOLVED IN THE
ENDOCRINE SYSTEM THYROID GLAND
 Located front of the trachea
HYPOTHALAMUS 1. T3- Triiodothyronine
 Located in the lower central part of the brain Rate of metabolism
2. T4- Thyroxine
 Controls satiety, body thermoregulation, homeostasis 3. Calcitonin - ↓calcium level in blood, it ↑the
 Links the nervous and endocrine system thru the pituitary absorption of Ca in teeth and bones
gland.

PARATHYROID GLAND
 Has 4 (2 pairs: 1 on each side)

1. Parathyroid hormone (PTH or Parathormone) -

PITUITARY GLAND (HYPOPHYSIS)
 Divided into 3 sections regulate calcium and phosphate balance
1. Posterior lobe (Neurohypophysis) - thru blood supply
2. PARS Intermedia THYMUS
3. Anterior lobe (Adenohypohysis) - thru nerves 1. Thymosin

POSTERIOR LOBE 2. Thymopoietin

-- both initaites the release of T-lymphocytes
 Antiduretic Hormone (ADH) or Vasopressin

 Oxytocin
- responsible for milk letdown PANCREAS
- uterine contractions
 Both have an endocrine (released thru the bloodstream),
and exocrine (thru ducts) function
PARS INTERMEDIA

 Melanocyte-stimulating Hormone (MSH) CELLS PRODUCED:

- for mood and sleep regulation 1. Alpha- glucagon
2. Beta- insulin
3. Delta- somatostatin
4. Acinar cells - the exocrine cell
ANTERIOR LOBE - produces enzymes (organic catalysts)

 Growth Hormone - Somatotropin A. Amylase - conversion of polysaccharide to glucose

 Thyrotropin RH -- TSH -- Thyroid Hormone B. Lipase - fats- lipids

 Corticotropin RH -- Adrenocorticotropic Hormone C. Protease - protein to amino acids

(ACTH) ADRENAL GLAND

 Gonadotropin RH
-- Luteinizing Hormone - stimulates the release of
hormones
1. Ovaries - estrogen, progesterone
2. Testes -Testosterone

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NCM 116: CARE OF CLIENTS W/ PROBS IN NUTRTION GI METABOLISM & ENDOCRINE,
PERCEPTION & COORD. ACUTE & CHRONIC W/ RLE 204 HOURS
NCM 116: ENDO

o Bulbous nose
o Huge jaw (macrognathia)
ADRENAL CORTEX (outside) o Headache
- has 3 layers: o Impaired vision
1. Flosa glomerulosa - mineralocorticoids (Aldosterone) o Large tongue
o Thick lips
2. Fasciculata - glucocorticoids (Cortisol)
o Lands hands and feet
3. Reticularis - androgen o Deeper voice

Diagnosis:
* collectively called as: Corticosteroids
- Based on physical appearance
- Gnawing pain due to headache

MINERALOCORTICOIDS
- maintains BP (aldosterone) - it helps in H20 and Na retention
- if BP ↓ - aldosterone is released (it stimulates Na + H2O to go
Test:
back into the bloodstream from the kidney tubules; allowing K  IGFR – 1 (Insulin-like Growth Factor
to be released into the urine) Hormone -1)
- Produced by the liver and promotes growth
- Stimulates GH production
GLUCORTICOIDS
- acts on the liver to stimulate glycogenesis to ↑ blood sugar  Oral Glucose Tolerance Test (OGTT)
- Instruct the patient to fast at night (8 hours
- immune system suppression: ↓pain perception = ↑risk for before) the procedure
infection - On the day of the test, instruct the patient to
- ↑osteoblastic activity = ↑osteoporosis ingest a bolus of glucose solution
-

ANDROGEN  MRI Scan

- male -- helps in the growth of prostate - To identify the location and size of the tumor

- female - in libido Treatment:

1. Surgery – removal of the pituitary gland
ADRENAL MEDULLA (inner) (transphenoidal hypophysectomy)

1. Epinephrine/ Adrenaline 2. Radiation Therapy

2. Norepinephrine/ Noradrenaline
MEDICATIONS
*collectively called as: Catecholamine  Bromocriptine
 Cabergoline
 Octreotide
GONADS
 Pegvisomant
1. Ovaries - estrogen, progesterone
NURSING DIAGNOSIS
2. Testes - testosterone - Pain
- Disturbed Body Image
KIDNEY
NURSING MANAGEMENT
1. Renin - ↓ BP - Monitor VS
2. Eryhtropoietin - RBC production - Assist patient in changes in body image
- Administer drug prescribed
ENDOCRINE DISORDERS
DWARFISM
GIGANTISM
- ↓ GH
- ↑ GH in childhood
- Can be detected during pregnancy
- Occurs before the closure of the epiphyseal plate
(long bones) - Can be rectify with GH, however, some can be
unresponsive
Signs and Symptoms:
- ↑ height, more than 7-8 ft

ACROMEGALY RENIN - ANGIOTENSIN- ALDOSTERONE SYSTEM

- ↑ GH in adulthood (RAAS)
- Occurs after the closure of the epiphyseal plate
affecting the short bones -helps control blood pressure
- the specifies cells of the kidney “juxtaglomerular
Signs and Symptoms: cells” releases “pro-renin”
o Bulging fontanels

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NCM 116: CARE OF CLIENTS W/ PROBS IN NUTRTION GI METABOLISM & ENDOCRINE,
PERCEPTION & COORD. ACUTE & CHRONIC W/ RLE 204 HOURS
NCM 116: ENDO

- if BP ↓ , pro-renin →Renin (acts on the liver to ALDOSTERONE ANTAGONISTS

produce Angiotensin (protein plasma), whill be
● Spiranolactone
converted into Angiotensin I. The lungs will release ● Eplrenone
● Finerenone
ACE to convert Angiotensin I to Angiotensin II which
will: NURSING MANAGEMENT
1. Monitor VS, I&O, weight px daily
A. Adrenal glands - ptoduce more aldosterone
2. Maintain Na restriction as ordered
B. Kidneys - ↑ reabsorption of H2O 3. Administer K-rich foods
4. Prep px for surgery if indicated
C. Systemic circulation - vasoconstriction
5. Provide client teaching on the meds to be
ACE INHIBITORS administered
6. Provide dx teaching and planning for home care
● Captopril Benazepril
● Lisinopril Moexipril
DIABETES INSIPIDUS
● Enalapril Perindopril
- when the kidneys are unable to conserve water
● Fosinopril Quinapril resulting in extreme thirst and frequent urination
Passage of large volume (>3L/24hr) of dilute urine
ANGIOTENSIN RECEPTOR BLOCKERS (ARBS)
(<30mOsm/kg)
● Telmisartan Candesartan
- results from adeficinecy of ADH
● Losartan Eprosartan
ADH = 1-5 pcg/mL
● Azilsartan
Signs and Symptoms:
CONN’S SYNDROME (Primary Hyperaldosteronism) o Polyuria
o Poludipsia
- a hormonal condition in which one or both adrenal o ↑ urine volume
glands produce more aldosterone than normal o Colorless, pale urine
- herediatry; rare o Nocturia
o Fatigue due to nocturia and interruption of sleep
CAUSES:
- adenoma of the PG
- hyperplasia of the PG Central DI - most common type of DI
- occurs when there is damage to the
Signs and Symptoms: posterior P.G
↑ aldosterone
Causes:
- hereditrary - idiopathic
o ↑ BP = ↑ Na =H2O = hypertension - tumors in the brain - head injury
o Headache
o Vision disturbances Nephrogenic DI - occurs when there is adequate ADH
but the kidneys fail to recognize it
↓K
Causes:
- hereditary
o Hypokalemia - intrinsic kidney disease
o Muscle weakness - antipsychotic drugs (Li Carbonate) /
o Cramps Lithium
o Numbness
o Muscle twitching Gestational DI - occurs when the placenta makes too
much enzymes that destroys ADH
DIAGNOSTIC TESTS
Dipsogenic DI - damage in the hypothalamus
 Electrolytes
Na = 135-145 mEq/L DIAGNOSTIC TEST:
K = 3.5-5.0 mmol/dL
 Water Deprivation Test
Aldosterone - The patient is deprived of fluids for 8 hours or until 5%
of the body mass has been lost. The patient needs to be
Urine = 3-25 mcg/24 hour
weighed hourly. Plasma osmolality is measured 4 hourly
Blood = <15 ng/dL and urine volume and osmolality every 2 h. At the end of
8 h the patient is given 2 mcg of intramuscular
 MRI
desmopressin and urine and plasma osmolality checked
 CT SCAN
over the next 4 h.
If serum osmolality rises to >305 mmol/kg the patient
TREATMENT
has diabetes insipidus and the test is stopped.
● Adrenalectomy - removal of adrenal glands
 Vasopressin test

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NCM 116: CARE OF CLIENTS W/ PROBS IN NUTRTION GI METABOLISM & ENDOCRINE,
PERCEPTION & COORD. ACUTE & CHRONIC W/ RLE 204 HOURS
NCM 116: ENDO

- After water deprivation test, a small dose of

vasopressin (AVP) is given thru injection. This will show CAUSES:
how the bidy reacts to the hormone, which helps to - Hashimoto disease
identify the type of DI. - Thyroidectomy
- Overuse of anti-0thyroid drugs
 Hypertonic Saline Infusion Test - Malfunction of the P.G
- a mixture of Na+H2O is given = maintain ADH level - Overuse of radioactive iodine

TREATMENT SIGNS AND SYMPTOMS

o Slow body metabolism
● Treat the underlying cause o Bradycardia
● Hormonal replacement :DESMOPRESSIN o Lethargic
● Thiazides - reduce GFR o Hypersensitivity to sedatives and barbiturates
- have PARADOXICAL EFFECT: S/E are opposite in o Weight gain
the desired outcome o Course, dry hair
o Course, brittle nail
VASOPRESSIN RELEASING DRUGS
o Personality changes (memory loss0
● Chlorpropamide
● Carbamazepine GI disturbance (constipation)
● Clofibrate o Menstrual irregularities
● Prostaglandin Inhibitors o Cold sensitivity

PROLACTINOMA MANAGEMENT
- tumor in the adenohypophysis (w/c release prolactin) - hormonal replacement
- it can cause symptoms:
o Infertility
o Irregular periods NURSING MANAGEMENT
o Milky nipple discharge 1. Allow ample time to finish activities
2. Promote warm environment
3. Provide skin/hair/nail care
TESTS
4. Orientation (time, place, person)
 CT SCAN & MRI -to determine the size and location
5. Monitor VS and hormone replacement
of the tumor
 Testosterone level blood test
GRAVE’S DISEASE / THYROTOXICOSIS/ BASEDOW
PROLACTIN LEVEL
DISEASE
 Men = <20ng/ml
 Non-pregnant women = <25ng/mL
- hyperfx of T.G= oversecretion of T.H
 Pregnant: 80-400 ng/mL
- incidence: women (20-40 y/o)
CRETINISM
CAUSES:
- affects thyroid hypofunction- resulting to inability to
- ↑TSH secretion if anterior P.G
synthesize T.H
- ↑ thyroid tumor
- defects in fetal development
- stress
- hashimoto disease
SIGNS AND SYMPTOMS
- infection
o Prolonged physiological jaundice
o Severe physical retardation = GROTESQUE SIGNS AND SYMPTOMS:
appearance o ↑body metabolism
o Sexual retardation o Weight loss inspite ravenous appetite
o Mental retardation o Irritability
o Apathy o Nervousness
o Dry, course, brittle hair o Fine tremors of the hand
o Dry skin o ↑systolic BP
o Large tongue o Heat intolerance
o Pot belly with umbilical hernia o Tachycardia
o Sensitivity to cold o Enlargement of T.G
o Poor feeding o Exophtalmus- external bulging of the eye
o Cardiac arrthymia
MANAGEMENT:
o Diarrhea
 Hormone replacement = Dessicated thyroid
(synthroid) o diaphoresis
 Is rapid response is needed = Thyroxine (Cytomel)
MANAGEMENT
 Diet - ↑CHONS, Ca, Vit D = promote skeletal - thyroidectomy - risk for hypothyroidism requiring
growth lifetime hormone therapy

MYXEDEMA -Radioactive iodine therapy - contraindicated during

- adult thyroid hypofx= resulting to undersecretion of T.H pregnancy -- leads to --abortion, cretinism
- incidence: 5x more common to women

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NCM 116: CARE OF CLIENTS W/ PROBS IN NUTRTION GI METABOLISM & ENDOCRINE,
PERCEPTION & COORD. ACUTE & CHRONIC W/ RLE 204 HOURS
NCM 116: ENDO

- drugs that control ↑ BP to treat the heart

A. Cardiac glycosides -- 2 effects
1. Inotropic (+) = ↑force of contraction of the heart
2. Chronotropic (-) = ↓ rate of contractions

B. Digoxin, Digitoxin
C. Vasodilators
D. Beta blockers (Propanolol, Atenolol, Metoprolol,
Acebutolol)

ANTI- THYROID DRUGS

● Saturated Solution of Potassium Iodide (SSKI)

- to decrease the size and vascosity of the glands

● Propylthiouracil (PT)
- blocks synthesize of T.H - should be taken with meal

● Methimazole
● Sodium iodide
● Potassium iodide

NURSING MANAGEMENT
1. Monitor VS
2. Provide high caloric diet; supplemental feedings
between meals
3. Explain the necessity of life-long intake of anti-thyroid
drugs for thoise with surgery
4. Avoid stress

COMPLICATIONS:

 Congestive heart failure

 Blindness
 Thyroid storm

AGRANULOCYTOSIS is a rare but serious complication

of antithyroid drug therapy

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